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NPI Code Detail

MEDICARE: UNITED SUPERMARKETS LLC

MEDICARE: UNITED SUPERMARKETS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical Supplies
2333600000XPharmacy
33336C0003XCommunity/Retail Pharmacy22751TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
32099062OTHERPK

General Provider Information

NPI Number : 1073651162
Entity Type Code : Organization
Provider Name (Legal Business Name) : UNITED SUPERMARKETS LLC
Provider Business Mailing Address
First Line : 250 E PARKCENTER BLVD
Second Line :
City : BOISE
State : ID
Zip : 83706-3940
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5605 COLLEYVILLE BLVD
Second Line :
City : COLLEYVILLE
State : TX
Zip : 76034-6022
Country : US
Telephone Number : 817-577-5030
Fax Number : 817-435-8075
Authorized Official
Title or Position : ENROLLMENTS MANAGER
Name : KATHY GIANNAKOPOULOS
Credential :
Telephone Number : 208-395-3954
Provider Enumeration Date : 02/02/2007
Last Update Date : 05/11/2026

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Practice Location Address:
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76034-6022
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Practice Fax: 817-503-7862

Directions to “UNITED SUPERMARKETS LLC ” Practice Location

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